BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Adolescents often create social relationships with their gaming peers who take on the role of offline friends and peer groups. Through collaboration and competition in the games, the social relationships of adolescents are becoming broader and thicker. Although this is a common phenomenon in online games, few studies have focused on the formation and roles of social capital among adolescent gamers. In particular, longitudinal research that examines the role of social capital in terms of influencing gaming time on adolescent gamers’ (...) psychosocial factors has been minimal. This study was designed to fill this gap to see the long-term effect of social capital among adolescent gamers. Specifically, by using the three-year longitudinal data involving 403 adolescents, we analyzed the effect of gaming time on psychological factors with the moderating role of social capital. Results showed that social capital played a crucial moderating role. In the higher social capital group, gaming time enhanced the degree of self-esteem and life satisfaction. However, a vicious circle was found in the lower social capital group: Gaming time increased the degree of depression but decreased self-esteem, which in turn led to increase in gaming time. These results indicate that games work as an important tool for social capital cultivation among adolescent gamers, which imply successful cultivation of social capital is a key to positive gaming effects. Theoretical and practical implications are discussed. (shrink)

Background Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. Methods This scoping review, conducted in December 2022, adhered (...) to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. Results The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. Conclusions Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape. (shrink)

When we evaluate moral agents, we consider many factors, including whether the agent acted freely, or under duress or coercion. In turn, moral evaluations have been shown to influence our (non-moral) evaluations of these same factors. For example, when we judge an agent to have acted immorally, we are subsequently more likely to judge the agent to have acted freely, not under force. Here, we investigate the cognitive signatures of this effect in interpersonal situations, in which one agent (“forcer”) forces (...) another agent (“forcee”) to act either immorally or morally. The structure of this relationship allowed us to ask questions about both the “forcer” and the “forcee.” Paradoxically, participants judged that the “forcer” forced the “forcee” to act immorally (i.e. X forced Y), but that the “forcee” was not forced to act immorally (i.e. Y was not forced by X). This pattern obtained only for human agents who acted intentionally. Directly changing participants’ focus from one agent to another (forcer vs. forcee) also changed the target of moral evaluation and therefore force attributions. The full pattern of judgments may provide a window into motivated moral reasoning and focusing bias more generally; participants may have been motivated to attribute greater force to the immoral forcer and greater freedom to the immoral forcee. (shrink)

Moral judgment depends critically on theory of mind, reasoning about mental states such as beliefs and intentions. People assign blame for failed attempts to harm and offer forgiveness in the case of accidents. Here we use fMRI to investigate the role of ToM in moral judgment of harmful vs. helpful actions. Is ToM deployed differently for judgments of blame vs. praise? Participants evaluated agents who produced a harmful, helpful, or neutral outcome, based on a harmful, helpful, or neutral intention; participants (...) made blame and praise judgments. In the right temporo-parietal junction, and, to a lesser extent, the left TPJ and medial prefrontal cortex, the neural response reflected an interaction between belief and outcome factors, for both blame and praise judgments: The response in these regions was highest when participants delivered a negative moral judgment, i.e., assigned blame or withheld praise, based solely on the agent's intent. These results show enhanced attention to mental states for negative moral verdicts based exclusively on mental state information. (shrink)

The issues of climate change and environmental degradation elicit diverse responses. This paper explores how an understanding of human moral psychology might be used to motivate conservation efforts. Moral concerns for the environment can relate to issues of harm or impurity . Aversions to harm are linked to concern for current or future generations, non-human animals, and anthropomorphized aspects of the environment. Concerns for purity are linked to viewing the environment as imbued with sacred value and therefore worthy of being (...) protected at all costs. While both harm-based and purity-based framings of environmental issues can sometimes backfire, we argue that making these moral concerns salient can nevertheless bring about moral responses to environmental issues. In sum, scientists' emerging knowledge about the moral mind can be used to facilitate the sustainable conservation of the planet. (shrink)

This paper considers what it is about violent video games that leads one reasonably minded person to declare “That is immoral” while another denies it. Three interpretations of video game content are discussed: reductionist, narrow, and broad. It is argued that a broad interpretation is required for a moral objection to be justified. It is further argued that understanding the meaning of moral utterances—like “x is immoral”—is important to an understanding of why there is a lack of moral consensus when (...) it comes to the content of violent video games. Constructive ecumenical expressivism is presented as a means of explaining what it is that we are doing when we make moral pronouncements and why, when it comes to video game content, differing moral attitudes abound. Constructive ecumenical expressivism is also presented as a means of illuminating what would be required for moral consensus to be achieved. (shrink)

Detailed studies of people who have experienced the Capgras delusion (the delusion that certain other people, usually close relatives, have been replaced by impostors) have led to advances in constructing an account which can deal with the basic symptomatology, testing alternative possibilities, generating and testing non‐trivial predictions, and broadening the scope of the basic account to encompass other delusions. This paper outlines these developments. It uses them to explore implications for understanding the formation and maintenance of beliefs, and to discuss (...) basic principles of what has come to be known as cognitive neuropsychiatry. (shrink)

The aim of this paper is to present a version of the principle of alternate possibilities which is not susceptible to the Frankfurt-style counter-example. I argue that PAP does not need to be endorsed as a necessary condition for moral responsibility and, in fact, presenting PAP as a sufficient condition maintains its usefulness as a maxim for moral accountability whilst avoiding Frankfurt-style counter-examples. In addition, I provide a further sufficient condition for moral responsibility – the twin world condition – and (...) argue that this provides a means of justifying why the protagonist in Frankfurt-style scenarios is still felt to be morally responsible. I conclude with the claim that neither the amended PAP nor the twin world condition is necessary for the ascription of moral responsibility; rather, what is necessary is simply that one of these conditions is satisfied. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

To be successful, policy must anticipate a broad range of constituents. Yet, all too often, technology policy is written with primarily mainstream populations in mind. In this article, drawing on Value Sensitive Design and discount evaluation methods, we introduce a new method—Diverse Voices—for strengthening pre-publication technology policy documents from the perspective of underrepresented groups. Cost effective and high impact, the Diverse Voices method intervenes by soliciting input from “experiential” expert panels. We first describe the method. Then we report on two (...) case studies demonstrating its use: one with a white paper on augmented reality technology with expert panels on people with disabilities, people who were formerly or currently incarcerated, and women; and the other with a strategy document on automated driving vehicle technologies with expert panels on youth, non-car drivers, and extremely low-income people. In both case studies, panels identified significant shortcomings in the pre-publication documents which, if addressed, would mitigate some of the disparate impact of the proposed policy recommendations on these particular stakeholder groups. Our discussion includes reflection on the method, evidence for its success, its limitations, and future directions. (shrink)

ArgumentNeuroscience research has created multiple versions of the human brain. The “social brain” is one version and it is the subject of this paper. Most image-based research in the field of social neuroscience is task-driven: the brain is asked to respond to a cognitive (perceptual) stimulus. The tasks are derived from theories, operational models, and back-stories now circulating in social neuroscience. The social brain comes with a distinctive back-story, an evolutionary history organized around three, interconnected themes: mind-reading, empathy, and the (...) emergence of self-consciousness. This paper focuses on how empathy has been incorporated into the social brain and redefined via parallel research streams, employing a shared, imaging technology. The concluding section describes how these developments can be understood as signaling the emergence of a new version of human nature and the unconscious. My argument is not that empathy in the social brain is a myth, but rather that it is served by a myth consonant with the canons of science. (shrink)

The increasing pressure from different facets of society exerted on multinational companies to become more philanthropic and claim ownership of their impacts is now becoming a standard practice. Although research in corporate social responsibility has arguably been recent, the application of activities taking a voluntary form from MNCs seem to vary reflecting a plethora of factors, particularly one obvious being the backwater local communities of developing countries where most of the natural extraction projects are located. This chapter examines views of (...) two Papua New Guinea local communities hosting large-scale mining operations and explains the demands arising from situational relativities, which are becoming too conspicuous for mine developers not to ignore. The research undertaken with several assertions highlights the perceived imperativeness allowing companies to integrate the CSR into the essential management pursuits of running mines in PNG. (shrink)

A bewildering array of accounts of the ontology of musical works is available. Philosophers have held that works of music are sets of performances, abstract, eternal sound-event types, initiated types, compositional action types, compositional action tokens, ideas in a composer’s mind and continuants that perdure. This paper maintains that questions in the ontology of music are, in Rudolf Carnap’s sense of the term, pseudo-problems. That is, there is no alethic basis for choosing between rival musical ontologies. While we have no (...) alethic basis for choosing any ontology of music, pragmatic reasons can be given for favoring certain ontologies of musical works over others. (shrink)

This chapter contains section titled: Art, Culture, and Appropriation Types of Cultural Appropriation What is a Culture? Objections to Cultural Appropriation In Praise of Cultural Appropriation.

This paper examines the relationship between knowing how to G and the ability to G, which is typically presented in one of the following ways: knowing how to G entails the ability to G; knowing how to G does not entail the ability to G. In an attempt to reconcile these two putatively opposing positions, I distinguish between type and token actions. It is my contention that S can know how to G in the absence of an ability to \, (...) where this action is derived from an action-type, but not in the absence of the ability to perform the action-type itself \\). This refinement is an attempt to reconcile differences between intellectualism and anti-intellectualism with regard to knowledge how and ability. (shrink)

It is argued that the Tractatus Project of Logical Atomism, in which the world is conceived of as the totality of independent atomic facts, can usefully be understood by conceiving of each fact as a bit in logical space. Wittgenstein himself thinks in terms of logical space. His elementary propositions, which express atomic facts, are interpreted as tuples of co-ordinates which specify the location of a bit in logical space. He says that signs for elementary propositions are arrangements of names. (...) Here, the names are understood as numerical symbols specifying coordinates. It is argued that, using this approach, the so-called colour-exclusion problem, which was Wittgensteins reason for abandoning the Tractatus, is in fact soluble. However, if logical space is a continuum then some coordinates will need to be expressed by numerical symbols that are infinite in size. How is this to be understood in Tractatus terms? It is shown that, in the Tractatus, Wittgenstein did recognise the possibility of infinite propositions and sentences expressing them. At first sight his approach to infinite sentences, and the approach of the present paper, seem to differ, but it is argued that the difference is superficial. Finally, we address the question of whether Logical Atomism is viable and this raises issues concerning its relationship to natural science. (shrink)

Phenomenally, we can distinguish between ownership of thought (introspective awareness) and authorship of thought (an awareness of the activity of thinking), a distinction prompted by the phenomenon of thought insertion. Does this require the independence of ownership and authorship at the structural level? By employing a Kantian approach to the question of ownership of thought, I argue that a thought being my thought is necessarily the outcome of the interdependence of these two component parts (ownership and authorship). In addition, whilst (...) still employing a Kantian approach, I speculate over possible mechanisms underlying the phenomenon of thought insertion. (shrink)

The correspondence theory of truth holds that each true sentence corresponds to a discrete fact. Donald Davidson and others have argued (using an argument that has come to be known as the slingshot) that this theory is mistaken, since all true sentences correspond to the same “Great Fact.” The argument is designed to show that by substituting logically equivalent sentences and coreferring terms for each other in the context of sentences of the form ‘P corresponds to the fact that P’ (...) every true sentence can be shown to correspond to the same facts as every other true sentence. The claim is that all substitution of logically equivalent sentences and coreferring terms takes place salva veritate. I argue that the substitution of coreferring terms in this context need not preserve truth. The slingshot fails to refute the correspondence theory. (shrink)

Family traditions take a somatic turn in a therapeutic practice that focuses on how bodies are passed down in families, not as assemblages of biological traits enjoined on the bodies of children by parents but as intentional fabrications devised by children out of the bodies of parents. Somatic psychology holds that parents offer children models of how to be embodied in the form of bodily attitudes. The body shapes I imitate and resist at every stage of life arise out of (...) the memory of the past, incarnate memory in the present, and project the memorial body toward its future. Taking up the techniques by which a person makes her body, the somatic psychologist induces her to unmake and remake it. This is a study of how the flesh remembers. (shrink)

Environmental ethicists rarely discuss the morality of using illegal tactics to protect the environment. Yet ecosabotage (or monkeywrenching) is the topic of numerous articles and books in the popular press. In this paper I examine what I consider to be the three strongest arguments against destroying property as a means of defending the environment: the social fabric argument, the argument for moral consistency, and the generalisation argument. I conclude that none of them provides an a priori obstacle to a consequentialist (...) justification of particular acts of ecosabotage. Then I sketch a version of constrained utilitarianism, which is capable, at least in principle, of justifying some acts of strategic ecosabotage in a democratic society. (shrink)

In Political Liberalism John Rawls argues that “the reasonable” and “the rational” are “two distinct and independent” ideas. This differentiation is essential to the viability of Rawls' conception of political liberalism insofar as it facilitates the recognition and subsequent voluntary acceptance of the need for a public conception of justice that requires all individuals to forsake the unfettered pursuit of their personal ambitions. However, the soundness of Rawls' argument is premised upon a number of questionable claims that, in effect, render (...) his proposed distinction between the reasonable and the rational more chimerical than real, and in so doing critically undermine the ability of his conception of justice to secure the type of voluntary public consensus he deems necessary to establish and sustain a just and stable liberal democracy. It is concluded that the only way one can be assured of generating the sought after conditions is to develop a regulatory framework that publicly supports and protects the principles embodied in Rawls' conception of reasonableness, rather than relying upon the reasonableness of individuals to secure and nourish the required conditions. S. Afr. J. Philos. Vol.24(4) 2005: 308-320. (shrink)

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Time distortion in individuals with social anxiety has been defined as the seemingly slower passage of time in social situations and is related to both arousal and valence. Consequently, adaptive behavior is disrupted and interpersonal situations avoided. We explored the effects of valence and arousal on time distortion in individuals with social anxiety. Participants were assigned to two groups, High Anxiety (HA) and Low Anxiety (LA), presented with four types of facial expression stimuli (positive-high arousal, positive-low arousal, negative-high arousal, and (...) negative-low arousal), and asked to estimate the duration of stimulus presentation. Results indicated that, relative to other stimuli, the HA and LA groups perceived longer presentation for high-arousal negative and low-arousal positive stimuli, respectively. These findings suggest that anxious individuals’ time distortion was more severe in situations that evoked high arousal and involved negative emotion. (shrink)

A collection of essays representing diverse approaches to feminist ethical analysis of social policy. Subjects include the Family and Medical Leave Act, combat exclusion and the role of women in the military, unwed fathers' rights, mail-order brides, pornography, breast implants, and sex-selective abortion. Paper edition (unseen), $17.95. Annotation copyrighted by Book News, Inc., Portland, OR.